A New Organizational Model for Preventing Inpatient Falls Using a Computerized Control System

Medical administrators continue to be challenged by the goal of providing safe and qualitative care to all patients. To the constant demand for care improvement and quality assurance in accordance with high standards expectations of safe care have been added. Despite efforts, the high incidence of patient's falls in a hospital setting remains unresolved.

Systemic review of the literature on fall prevention in hospitals has found no consistent evidence regarding the effectiveness of single or multiple interventions to prevent falls. Research on the prevention of inpatient falls has largely focused on two main areas: (1) Patient risk factors related to inpatients falls and (2) Interventions (fall risk assessment, armbands, medication review and use of physical restraints) to reduce falls in hospitals. Findings nonetheless show that inpatient falls cannot be resolved by any one measure.

Purpose: To assess introduction of a new organizational model for reducing rates of inpatient falls based on a computerized control system operating­ in three essential spheres.

Method: The intervention was introduced in 2013 in a major medical center (1,500 beds, 120 wards, 2,500 nurses) located in Israel within the framework of the International Joint Commission for Hospital Accreditation. The intervention program was implemented in three spheres.

Sphere 1: Declaration by nursing management of policy aimed at reducing the incidence of patient falls and minimizing the harm from falls during hospitalization. The intervention focused on changing perception of this issue by increasing knowledge and awareness among all levels of the caregiving staff, from nurses' shift managers to auxiliary caregivers, by using an e-learning course and participation in dedicated seminars. These training programs followed up with computerized control reports, which received by deputy nurses.

Sphere 2: Introduction of a computerized control system to ensure that all patient fall risk factors are assessed and appropriate intervention documented according to the adopted prevention policy. The reports enabled nurses in charge as well as nursing management to identify the effective aspects of fall prevention requiring reinforcement in addition to those aspects requiring immediate intervention.

Sphere 3: Introduction of a computerized control system enabling real-time transmission of alerts and information on each fall incident documented in the patient's file. In response to the current data, the nursing management introduced a post-fall assessment procedure to be completed immediately after the incident. This data also enabled profiling patients who fell during hospitalization together with provision of immediate as well as quarterly feedback to all nurse managers regarding their meeting of the annual fall-reduction goals defined by nursing management (reduction of fall rate by at least 10% annually).

All three spheres were accompanied by deputy nurse's assigned responsibility for inpatient fall prevention, who acted under the direction and supervision of the Supervisor of Fall Prevention.

Assessment of the project's implementation indicated attainment of the goals set: During the first three quarters of 2015, there was a 20% reduction of reported falls when compared with the equivalent period in 2014.

This model for the promotion and improvement of patient care by means of a computerized control system was shown to be effective in assisting decision-making in other areas of care as well, such as prevention of bedsores and pain reduction. Pivotal aspects of the program and its implementation will be discussed further during the presentation.